〔Abstract〕 Objective To observe the efficacy of combined positive pressure ventilation on neonatal respiratory distress syndrome (NRDS). Methods 120 cases of NRDS were treated from March 2018 to March 2019 were observed and divided into two groups according to different treatment methods. 60 patients were treated with double-level positive pressure ventilation and 60 patients with double-level positive pressure ventilation combined with alveolar surfactant to compare the efficacy of the two groups. Results Respiratory index before and after treatment between the two groups (P > 0.05). The observation group was significantly better compared to the control group (P < 0.05); the incidence of adverse treatment was significantly lower than the control group and significantly significant (P < 0.05). Conclusion Double-level positive pressure ventilation in children with NRDS has a significant clinical effect, fewer complications, safety and effectiveness.